Provider Demographics
NPI:1710069257
Name:MCCONAUGHY, SUSAN JILL (CNM)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JILL
Last Name:MCCONAUGHY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10465 PARK MEADOWS DRIVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:303-799-7903
Mailing Address - Fax:303-799-1222
Practice Address - Street 1:10465 PARK MEADOWS DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-799-7903
Practice Address - Fax:303-799-1222
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO64072367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07640725Medicaid
COCO304443Medicare PIN